SWL literature
Slider

Klein J et al, 2018: [Extracorporeal shock wave lithotripsy].

Klein J, Netsch C, Sievert KD, Miernik A, Westphal J, Leyh H, Herrmann TRW, Olbert P, Häcker A, Bachmann A, Homberg R, Schoenthaler M, Rassweiler J, Gross AJ.
Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstr. 43, 89075, Ulm, Deutschland.
Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland.
Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland.
Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland.
Klinik für Urologie und Kinderurologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland.
Urologische Klinik, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland.
Spital Thurgau AG, Kantonsspital Frauenfeld, Klinik für Urologie, Frauenfeld, Schweiz.
BRIXSANA, private clinic, Brixen, Italien.
Klinik für Urologie, Haus 28, Universitätsklinikum Mannheim, Mannheim, Deutschland.
alta uro Praxis für Urologie, Basel, Schweiz.
Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland.
Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland.

Abstract

Interventional treatment of stones essentially consists of three treatment modalities. Extracorporeal shockwave lithotripsy (ESWL), in addition to uterorenoscopy (URS) and percutaneous nephrolitholapaxy (PCNL) is an essential treatment pillar and is the only noninvasive therapy option for the treatment of urinary stones. After a long period of ESWL being the leading choice in stone treatment, the number of SWL interventions diminished in recent years in favor of the other two treatment modalities (URS and PCNL). This article describes the indications, surgical technique and management of complications of SWL.

Urologe A. 2018 Mar 8. doi: 10.1007/s00120-018-0611-9. [Epub ahead of print] German.

 

0
 

Comments 1

Hans-Göran Tiselius on Friday, 27 July 2018 11:21

For those colleagues who can read German, this article is an excellent overview of factors important to consider during SWL. Such knowledge is of fundamental importance for optimizing the treatment. The need of rules in this regard is evident from the fact that in too many centres SWL is carried out in a too stereotypic and sloppy way, without sufficient attention to the details necessary for a successful outcome.

Several other articles have dealt with aspects on the technical details of SWL [1,2], but there are some points in this educational text that are infrequently mentioned in the literature and need to be emphasized:

• the need to remove hair from the body surface at the entry point of SW to improve energy transmission

• the absolute need of gas-free transmission medium

• positioning the stone in focus during the expiratory phase

• ramping to avoid over-treatment in terms of SW number and energy levels. In this regard the use of a bladder catheter and forced diuresis to detect early hematuria as a reflection of stone disintegration has in the reviewer's experience been very helpful.

One section of the text includes a discussion of measures of value to apply after SWL. Diclofenac , in the hand of the author of this comment, has turned out to be very useful to avoid emergency visits caused by pain during fragment passage.

The general statement by the authors of the article is that although both URS and PCNL are used with increasing frequency, SWL is still a very useful and commonly applied technique with the major advantage of being non-invasive.


References

1. Tiselius HG, Chaussy CG.
Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones.
Urolithiasis. 2015 Oct;43(5):387-96. doi: 10.1007/s00240-015-0818-9. Epub 2015 Aug 28. Review.

2. Chaussy CG, Tiselius HG.
How can and should we optimize extracorporeal shockwave lithotripsy?
Urolithiasis. 2018 Feb;46(1):3-17. doi: 10.1007/s00240-017-1020-z. Epub 2017 Nov 25. Review

For those colleagues who can read German, this article is an excellent overview of factors important to consider during SWL. Such knowledge is of fundamental importance for optimizing the treatment. The need of rules in this regard is evident from the fact that in too many centres SWL is carried out in a too stereotypic and sloppy way, without sufficient attention to the details necessary for a successful outcome. Several other articles have dealt with aspects on the technical details of SWL [1,2], but there are some points in this educational text that are infrequently mentioned in the literature and need to be emphasized: • the need to remove hair from the body surface at the entry point of SW to improve energy transmission • the absolute need of gas-free transmission medium • positioning the stone in focus during the expiratory phase • ramping to avoid over-treatment in terms of SW number and energy levels. In this regard the use of a bladder catheter and forced diuresis to detect early hematuria as a reflection of stone disintegration has in the reviewer's experience been very helpful. One section of the text includes a discussion of measures of value to apply after SWL. Diclofenac , in the hand of the author of this comment, has turned out to be very useful to avoid emergency visits caused by pain during fragment passage. The general statement by the authors of the article is that although both URS and PCNL are used with increasing frequency, SWL is still a very useful and commonly applied technique with the major advantage of being non-invasive. References 1. Tiselius HG, Chaussy CG. Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones. Urolithiasis. 2015 Oct;43(5):387-96. doi: 10.1007/s00240-015-0818-9. Epub 2015 Aug 28. Review. 2. Chaussy CG, Tiselius HG. How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis. 2018 Feb;46(1):3-17. doi: 10.1007/s00240-017-1020-z. Epub 2017 Nov 25. Review
Guest
Tuesday, 25 June 2019
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com